Buprenorphine uptake during pregnancy increases following guideline updates

Following guideline updates for the treatment of opioid use disorder, pregnant women increasingly used buprenorphine compared with nonpregnant women.

Given increases in prenatal opioid use disorder (OUD), in August 2017, ACOG and the American Society of Addiction Medicine (ASAM) expanded their guidelines for treating OUD in pregnancy to include buprenorphine. Until then, only methadone was recommended by these organizations for treating pregnant women with OUD.

“Still, evidence shows that pregnant patients receive medications for OUD at low rates, and face barriers when seeking treatment (especially with regards to accessing buprenorphine), and few obstetrician-gynecologists are licensed to prescribe buprenorphine,” Max Jordan Nguemeni Tiako, MD, MS, a resident physician at Brigham and Women’s Hospital in Boston, and colleagues wrote.

Nguemeni Tiako and colleagues used MarketScan Commercial Claims and Encounters Data (IBM Watson Health) to compare changes in buprenorphine uptake between pregnant and nonpregnant women between 2014 and 2019.

The sample included 86,522 women aged 15 to 45 years, 2,137 (2.5%) of whom were pregnant at least once. Among these, the mean age at baseline was 27.6 years (standard deviation [SD], 6 years). The mean age at baseline among nonpregnant women was 30.9 years (SD, 7.9 years). Most patients (n = 70,704; 81.7%) lived in urban areas.

Compared with nonpregnant women, pregnant women had a 2.1 percentage point (95% CI, 1-3.2) increase in buprenorphine use after the guideline change. This equated to a 12% increase compared with the period prior to the guideline change.

A sensitivity analysis excluding 2017 demonstrated a similar increase in buprenorphine use in pregnant women (2.3 percentage points; 95% CI, 0.8-3.7).

Among women who had never received treatment for OUD, the buprenorphine initiation rate increased from 12 to 13 initiations per 100 person-years in nonpregnant women, and from 17 to 21 initiations per 100 person-years in pregnant women.

“Our findings suggest that ACOG-ASAM’s 2017 OUD guidelines led to increased buprenorphine uptake among pregnant women with OUD compared to nonpregnant women,” Nguemeni Tiako and colleagues wrote. “Professional society guidelines could be an effective tool to address the current U.S. drug overdose epidemic.”